scholarly journals Placental function in maternal obesity

2020 ◽  
Vol 134 (8) ◽  
pp. 961-984 ◽  
Author(s):  
Amy C. Kelly ◽  
Theresa L. Powell ◽  
Thomas Jansson
Keyword(s):  
Pregnant Women ◽  
Maternal Obesity ◽  
Normal Weight ◽  
Adverse Outcomes ◽  
Obese Women ◽  
Long Term Outcomes ◽  
Placental Function ◽  
High Insulin ◽  
Short And Long Term

Abstract Maternal obesity is associated with pregnancy complications and increases the risk for the infant to develop obesity, diabetes and cardiovascular disease later in life. However, the mechanisms linking the maternal obesogenic environment to adverse short- and long-term outcomes remain poorly understood. As compared with pregnant women with normal BMI, women entering pregnancy obese have more pronounced insulin resistance, higher circulating plasma insulin, leptin, IGF-1, lipids and possibly proinflammatory cytokines and lower plasma adiponectin. Importantly, the changes in maternal levels of nutrients, growth factors and hormones in maternal obesity modulate placental function. For example, high insulin, leptin, IGF-1 and low adiponectin in obese pregnant women activate mTOR signaling in the placenta, promoting protein synthesis, mitochondrial function and nutrient transport. These changes are believed to increase fetal nutrient supply and contribute to fetal overgrowth and/or adiposity in offspring, which increases the risk to develop disease later in life. However, the majority of obese women give birth to normal weight infants and these pregnancies are also associated with activation of inflammatory signaling pathways, oxidative stress, decreased oxidative phosphorylation and lipid accumulation in the placenta. Recent bioinformatics approaches have expanded our understanding of how maternal obesity affects the placenta; however, the link between changes in placental function and adverse outcomes in obese women giving birth to normal sized infants is unclear. Interventions that specifically target placental function, such as activation of placental adiponectin receptors, may prevent the transmission of metabolic disease from obese women to the next generation.

scholarly journals The impact of gestational diabetes and maternal obesity on the mother and her offspring

2010 ◽  
Vol 1 (4) ◽  
pp. 208-215 ◽  
Author(s):  
P. M. Catalano
Keyword(s):  
Insulin Resistance ◽  
Gestational Diabetes ◽  
Glucose Intolerance ◽  
Maternal Obesity ◽  
Insulin Response ◽  
Obese Women ◽  
Increased Risk ◽  
Short And Long Term ◽  
The Impact

Thein uteromaternal metabolic environment is important relative to both short and long term development of the offspring. Although poor fetal growth remains a significant factor relative to long-term outcome, fetal overgrowth is assuming greater importance because of the increase in obesity in the world’s populations. Maternal obesity and gestational diabetes are the most common metabolic complications of pregnancy related to fetal overgrowth and more specifically adiposity.Women with gestational diabetes have increased insulin resistance and inadequate insulin response compared with weight-matched controls. Gestational diabetes increases the risk of maternal hypertensive disease (preeclampsia) as well as cesarean delivery. At birth the neonate has increased adiposity and is at risk for birth injury. Multiple studies have reported that children of women with gestational diabetes have a greater prevalence childhood obesity and glucose intolerance; even at glucose concentrations less than currently used to define gestational diabetes, compared with normoglycemic women.Obese women also have increased insulin resistance, insulin response and inflammatory cytokines compared with average weight women both before and during pregnancy. They too are at increased risk for the metabolic syndrome-like disorders during pregnancy that is hypertension, hyperlipidemia, glucose intolerance and coagulation disorders. Analogous to women with gestational diabetes, neonates of obese women are heavier at delivery because of increased fat and not lean body mass. Similarly, these children have an increased risk of childhood adiposity and metabolic dysregulation. Hence, the preconceptional and perinatal period offers a unique opportunity to modify both short and long term risks for both the woman and her offspring.

Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling

2015 ◽  
Vol 27 (2) ◽  
pp. 247-253 ◽  
Author(s):  
Inês Pereira ◽  
Alexandre Valentim-Lourenço ◽  
Catarina Castro ◽  
Inês Martins ◽  
Alexandra Henriques ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Obese Women ◽  
Long Term Outcomes ◽  
Transobturator Sling ◽  
Incontinence Surgery ◽  
Short And Long Term

scholarly journals Biomarkers of acute kidney injury and associations with short- and long-term outcomes

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 986 ◽  
Author(s):  
Jennifer A. Schaub ◽  
Chirag R. Parikh
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Future Research ◽  
Long Term Outcomes ◽  
Medical Researchers ◽  
Novel Biomarkers ◽  
Short And Long Term

Acute kidney injury is strongly associated with increased mortality and other adverse outcomes. Medical researchers have intensively investigated novel biomarkers to predict short- and long-term outcomes of acute kidney injury in many patient care settings, such as cardiac surgery, intensive care units, heart failure, and transplant. Future research should focus on leveraging this relationship to improve enrollment for clinical trials of acute kidney injury.

scholarly journals Effects of maternal obesity on placental function and fetal development

Reproduction ◽  
2017 ◽  
Vol 153 (3) ◽  
pp. R97-R108 ◽  
Author(s):  
Kristy R Howell ◽  
Theresa L Powell
Keyword(s):  
Fetal Development ◽  
Maternal Obesity ◽  
Critical Role ◽  
Obese Women ◽  
Necrosis Factor Alpha ◽  
Nutrient Delivery ◽  
Placental Function ◽  
Metabolic Hormones ◽  
Increased Risk

Obesity has reached epidemic proportions, and pregnancies in obese mothers have increased risk for complications including gestational diabetes, hypertensive disorders, pre-term birth and caesarian section. Children born to obese mothers are at increased risk of obesity and metabolic disease and are susceptible to develop neuropsychiatric and cognitive disorders. Changes in placental function not only play a critical role in the development of pregnancy complications but may also be involved in linking maternal obesity to long-term health risks in the infant. Maternal adipokines, i.e., interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), leptin and adiponectin link maternal nutritional status and adipose tissue metabolism to placental function. Adipokines and metabolic hormones have direct impact on placental function by modulating placental nutrient transport. Nutrient delivery to the fetus is regulated by a complex interaction including insulin signaling, cytokine profile and insulin responsiveness, which is modulated by adiponectin and IL-1β. In addition, obese pregnant women are at risk for hypertension and preeclampsia with reduced placental vascularity and blood flow, which would restrict placental nutrient delivery to the developing fetus. These sometimes opposing signals regulating placental function may contribute to the diversity of short and long-term outcomes observed in pregnant obese women. This review focuses on the changes in adipokines and obesity-related metabolic hormones, how these factors influence placental function and fetal development to contribute to long-term metabolic and behavioral consequences of children born to obese mothers.

P4730Underweight is associated with unfavourable short- and long-term outcomes after MitraClip therapy: a body mass index derived subgroup analysis of the German Transcatheter Mitral Valve Interventions (

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Kalbacher ◽  
E P Tigges ◽  
P Boekstegers ◽  
M Puls ◽  
B Plicht ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cardiac Output ◽  
Mitral Valve ◽  
Normal Weight ◽  
Long Term Outcomes ◽  
Low Cardiac Output ◽  
Short And Long Term ◽  
Underweight Patients ◽  
Mitraclip Therapy

Abstract Background Underweight and obesity represent classical risk factors for patients undergoing cardiac surgery or interventional treatment. The multicentre German Transcatheter Mitral Valve Interventions (TRAMI) registry comprises a large and prospectively enrolled real-world cohort of patients treated by MitraClip implantation. Aims The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy. Methods and results From 08/2010 until 07/2013, 799 patients (age 75.3±8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicentre, industry-independent German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into four groups: BMI<20 kg/m2 (underweight, n=49), BMI 20.0 to <25.0 kg/m2 (normal weight, n=293), BMI 25.0 to <30.0 kg/m2 (overweight, n=296) and BMI≥30 kg/m2 (obese, n=132). Procedure and radiation time were comparable among all groups. Significant increased rates of procedural failure (12.2% vs. 2.1 [normal weight], p<0.001), transfusion/bleeding (20.8% vs. normal weight: 5.6%, obesity: 7.0%, p<0.01), sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, p<0.01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine≥1.5mg/dl, diabetes, left ventricular ejection fraction<30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR]: 1.58, 95%-confidence interval (CI): 1.01–2.46, p=0.044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55–0.93; p=0.011). Conclusion Underweight patients are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates when undergoing MitraClip implantation and should therefore be carefully discussed within the heart team. Acknowledgement/Funding The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott.

scholarly journals Evaluating the effectiveness of an educative workshop for pregnant women using pre and post intervention surveys

2019 ◽  
Vol 35 (10) ◽  
Author(s):  
Rodrigo Dias Nunes ◽  
Ana Gabriela Puel ◽  
Natália Gomes ◽  
Jefferson Traebert
Keyword(s):  
Pregnant Women ◽  
Newborn Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Long Term Outcomes ◽  
Post Intervention ◽  
Cross Sectional ◽  
Time Points ◽  
Short And Long Term

Abstract: This paper will report the findings of an education intervention performed by a workshop aimed to provide pregnant women with knowledge about pregnancy, delivery, breastfeeding and newborn care. A cross-sectional study, using a pre and post-intervention research design, was performed with 105 pregnant women from an obstetric service for a two-year period. Time points (pre and post) were compared using either Student t test and ANOVA. Significance was set at p ≤ 0.05. After the intervention all items increased their level from the three stations: antenatal care (20.4%), labor and delivery (36.8%) and postnatal and breastfeeding (32.1%). The total score of the surveys also increased 31.7% when comparing the pre and post applications (p < 0.001). It was evidenced the importance of strategies to improve knowledge about pregnancy and its surroundings to pregnant women. The workshop proposal presented increases in its knowledge and can most likely bring better results in short and long-term outcomes.

scholarly journals Maternal Obesity and the First Birth: A Case for Targeted Contemporary Maternity Care

2014 ◽  
Vol 4 (2) ◽  
pp. 120-129
Author(s):  
Valerie J. Slavin ◽  
Jennifer Fenwick ◽  
Jenny Gamble
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Birth Outcomes ◽  
Maternity Care ◽  
Maternal Obesity ◽  
Clinical Audit ◽  
Normal Weight ◽  
Obese Women ◽  
Model Of Care ◽  
First Birth

BACKGROUND: Obesity in childbearing women is associated with poorer pregnancy and birth outcomes, particularly caesarean section, compared with normal-weight women. The high caesarean section rate may reflect care and outcomes which occur at the time surrounding the first birth.AIM: To describe the birth outcomes of extremely obese pregnant women (body mass index [BMI] of 40 or more) experiencing their first birth.METHODS: Clinical audit was used to systematically review the care and birth outcomes of all extremely obese pregnant women experiencing their birth at one study site during a 2-year period in 2009 and 2010. Fifty participants birthed during the study period. Data were collected from booking to discharge from the maternity service and included variables such as model of care, number of appointments, and obstetric and neonatal outcomes. Descriptive statistics were used to describe and synthesize the data. Inferential statistics were used to draw inferences about the population.RESULTS: Obese women rarely had contact with a midwife, except at booking, receiving a standard model of care provided by numerous caregivers, most often inexperienced medical staff. More than half of the obese women experienced a caesarean section (56%), 2.3 times that of normal-weight primiparous women who birthed at the study site during the same period (24.2%). This was despite 64% experiencing normal pregnancy free from any complication. For women who planned to labor, birth intervention including induction of labor, augmentation for slow labor, epidural, and continuous cardiotocography was high. Caesarean occurred most often for “failure to progress” and “failed induction.”CONCLUSION: Clinical audit was useful in determining information, which suggests current maternity care provision is not meeting the needs of extremely obese women experiencing their first birth.IMPLICATIONS FOR PRACTICE: The development of effective, targeted antenatal care designed to meet the needs of extremely obese women is recommended as are strategies to keep birth normal.

scholarly journals Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of “Metabolic Memory”

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Akadiri Yessoufou ◽  
Kabirou Moutairou
Keyword(s):  
Gestational Diabetes ◽  
Maternal Obesity ◽  
Maternal Diabetes ◽  
Adverse Outcomes ◽  
Metabolic Memory ◽  
Obese Women ◽  
Diabetes In Pregnancy ◽  
Obesity And Diabetes ◽  
In Pregnancy

The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/or obesity at adulthood. This “fetal programming”, due to intrauterine diabetic milieu, is termed as “metabolic memory”. In gestational diabetes as well as in macrosomia, the complications include metabolic abnormalities, degraded antioxidant status, disrupted immune system and potential metabolic syndrome in adult offspring. Furthermore, there is evidence that maternal obesity may also increase the risk of obesity and diabetes in offspring. However, women with GDM possibly exhibit greater macrosomia than obese women. Obesity and diabetes in pregnancy have independent and additive effects on obstetric complications, and both require proper management. Management of gestational diabetes mellitus and maternal obesity is essential for maternal and offspring's good health. Increasing physical activity, preventing gestational weight gain, and having some qualitative nutritional habits may be beneficial during both the pregnancy and offspring's future life.

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